Provider Demographics
NPI:1548230683
Name:SANFORD MEDICAL CENTER
Entity Type:Organization
Organization Name:SANFORD MEDICAL CENTER
Other - Org Name:SANFORD CLINIC ESTELLINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP, REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:TONY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MORRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-328-8380
Mailing Address - Street 1:PO BOX 5074
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5074
Mailing Address - Country:US
Mailing Address - Phone:605-328-6585
Mailing Address - Fax:
Practice Address - Street 1:305 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:ESTELLINE
Practice Address - State:SD
Practice Address - Zip Code:57234-0196
Practice Address - Country:US
Practice Address - Phone:605-873-2222
Practice Address - Fax:605-873-2182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-23
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5300860Medicaid
SDS5971Medicare PIN
SDCH8874Medicare PIN
SD5300860Medicaid
SD433858Medicare Oscar/Certification